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General NPI Number Information
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NPI Number | 1487516118
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Entity Type | Individual
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Provider Name | LAKEISHA ROBERTSON
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 3659 LORNA RD STE 139
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City | HOOVER
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State | AL
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Zip | 35216-5959
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Country | US
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Telephone | 662-524-5428
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Fax |
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Provider Business Mailing Address
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Address Line | 325 CHAPEL HILL TRL
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City | FULTONDALE
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State | AL
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Zip | 35068-6078
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Country | US
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Telephone | 662-524-5428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | S36T1C738G
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License Number State | AL
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